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Prediction Instruments and Clinical Judgment in Critical Care

Marc D. Silverstein, MD
JAMA. 1988;260(12):1758-1759. doi:10.1001/jama.1988.03410120104036.
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The development and dissemination of powerful, effective, and costly technologies for monitoring and treating lifethreatening illness have resulted in the widespread availability of intensive care units (ICUs) in hospitals. Medical ICUs admit acutely ill patients, chronically ill patients with 'an exacerbation, and, on occasion, terminally ill patients for monitoring and supportive treatment. Patients, their families, physicians, government, and third-party payers have been concerned about the high mortality rates among critically ill patients, the functional outcomes of survivors of intensive care, the costs of care, and decision making for the critically ill.11

Studies of patients in medical ICUs have indicated that the ICU patient population comprises two different groups: critically ill persons who receive intensive therapeutic interventions (eg, the patient with septic shock and multisystem organ failure) and persons with serious conditions who receive intensive monitoring and observation for life-threatening complications amenable to prompt intervention (eg, the patient with


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